As North Carolina pursues a Medicaid reform program that will require a waiver from the federal government, Jason Hart writes at National Review Online about another state that has hit a brick wall when trying to address a similar issue.

Critics of Medicaid expansion were vindicated again last week when the Obama administration denied Ohio’s request to incorporate HSA (health savings account) features into the state Medicaid program. Opponents of Governor John Kasich’s 2013 expansion of Medicaid to childless, able-bodied, working-age Ohioans argue that hospital lobbyists, federal bureaucrats, and cowed state lawmakers will make future reform — much less repeal — nearly impossible. Now, officials in the federal Centers for Medicare and Medicaid Services have dealt welfare-reform advocates another setback, killing a proposal to require some of the adults in Ohio’s Medicaid program to pay meager monthly HSA contributions. …

… Since Kasich took office in 2011, Ohio’s total Medicaid enrollment has increased by more than a third. Ohio Medicaid spending skyrocketed from $17 billion in 2011 to $25 billion in 2016. HOP would have barely put a dent in the expansion’s new costs, which are on track to double the $13 billion that Kasich projected for 2014–20. Federal taxpayers have been stuck with the nearly $10 billion tab already run up for Ohio’s Medicaid expansion, but Ohio taxpayers will have to fork over 5 percent of its $400 million monthly costs starting in January.

Even when Republican governors have asked to customize Medicaid as a precondition for expanding it, the Obama administration has shown little willingness to negotiate. Ohio’s HOP proposal is a watered-down version of conservative lawmakers’ attempts to emulate the Healthy Indiana Plan, an HSA program gutted by Governor Mike Pence in return for Obamacare money. Arkansas governor Asa Hutchinson agreed to continue his state’s Obamacare expansion in return for similarly feeble Medicaid waivers.

Unlike Pence and Hutchinson, who made a show of holding out for waivers before embracing Obamacare, Kasich framed Medicaid expansion as a fiscal and moral imperative. When Ohio’s legislature refused to expand Medicaid, Kasich did so unilaterally.

Other governors should pay attention to what’s happening in Ohio, says Jonathan Ingram, vice president of research at the free-market Foundation for Government Accountability. “The federal government’s rejection of Ohio’s waiver request should serve as another warning to states that have rejected Medicaid expansion,” Ingram said. “As usual, Washington bureaucrats hold all the cards, and they’re interested in only one thing: expanding welfare to more able-bodied adults.”